If today’s “virtual care” is not the answer for people with chronic conditions, what is?


The Covid-19 pandemic pushed the medical industry to offer high quality care at a distance, and many patients are finding it easier to consult their physician than ever before. This is undoubtedly a positive development, but it is not a paradigm shift. Contemporary virtual care is not the revolutionary change that the industry needs.

Today’s “virtual care” makes use of technologies – video, chat, security, privacy – to mediate the time-constrained relationship between overloaded medical professionals and patients. But it fails to acknowledge the fact that most chronic care is actually done outside that relationship, during day-to-day life, leaving patients to take on their everyday health decisions without adequate support.

Where does modern virtual care go wrong?

Virtual care 1.0 – which we can think of as a first attempt – does offer significant benefits to patients. Not having to travel to see a doctor, especially for people who are busy, unwell or have mobility issues, is a major improvement over the default assumption that appointments occur in person. It is also a great solution for regular check-ins.

However, virtual care runs into the same fundamental issue as analog care when it comes to more complex cases such as chronic conditions. Chronic care patients need 24×7 support, yet they only receive minutes of expert attention per month. They are then released into the world to make complex medical decisions by themselves.

Consider, for example, the case of a person with type 1 diabetes, a condition which affects over 1.6 million Americans. Research by academics at Stanford University has found that they must make an average of 180 consequential diabetes-related decisions every day.

Leaving these people to make these decisions unsupported is simply not working. Eighty percent of people with type 1 diabetes don’t achieve the recommended HbA1c target, and they’re two to three times more likely than other members of the public to experience fatigue, anxiety, stress and depression.

The human capacity required to genuinely assist people with type 1 diabetes in their daily life is beyond comprehension – and that’s just one condition. There simply aren’t enough professional doctors in the world to take on this amount of care delivery, no matter how much technology is provided to optimize their workflow.

Centering the patient 

Genuinely improving the care that people with chronic conditions receive requires reimagining the care system, not simply digitizing the traditional analog healthcare delivery model. One concept that the current system neglects is that people with long-term conditions already act, in many ways, as their own care providers. They take in expert advice through their interactions with the medical establishment and then learn what works for them through trial and error.

The future – virtual care 2.0 – must build upon this understanding and focus on a new KPI: patient autonomy, the ability of a person to treat themselves effectively and feel confident in their decisions.

What needs to change to get to virtual care 2.0?

We have the data, technology and ingenuity needed to dramatically improve patient autonomy, but the industry needs to change in three critical ways to achieve it. The first is respect for the patient. A paternalistic “doctor knows best” attitude often permeates the entire care process at the expense of the patient. While many industries have been obsessed with consumer engagement for over a decade, the medical industry is still stuck on “adherence” and “compliance.”

Adopting an attitude where the patient isn’t just a “passenger” in their own care, but the driving force, will produce better outcomes and move the industry forward.

The second area that the industry needs to work on is curiosity. Rather than blaming patients for not adhering to or complying with proposed solutions, we need to investigate why they aren’t following recommendations (often because it’s not possible) and reframe problems in solvable ways. This will take us well beyond purely medical problems into the complex and messy world of reality. Only by engaging with the challenges that patients face – medical and otherwise – can the industry hope to provide effective solutions.

The third area to change is humility. We know far less than we think we do about many chronic conditions such as diabetes, let alone about the people who live with these conditions. For instance, the widespread imagining of people with diabetes as unconcerned about their health, or “fat and lazy” doesn’t reflect a person’s lived experience – many people follow their doctor’s directions to the letter and still don’t achieve their desired health outcomes. Innovator arrogance is a major blocker to innovation here.

The future of care is patient-focused

Simply expanding the medical status quo into the virtual world doesn’t resolve some of its deepest limitations, particularly in chronic care. Using technology to empower patients to effectively manage their own care will deliver better results and potentially end the unacceptable trend of poor outcomes in chronic care.

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